Provider Demographics
NPI:1982828257
Name:MOBSON CARE INCORPORATED
Entity Type:Organization
Organization Name:MOBSON CARE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BRANCH COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MOBOLAJI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIWONIKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-286-5224
Mailing Address - Street 1:6269 CENTURY BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55429-1030
Mailing Address - Country:US
Mailing Address - Phone:763-286-5224
Mailing Address - Fax:763-560-3137
Practice Address - Street 1:6269 CENTURY BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55429-1030
Practice Address - Country:US
Practice Address - Phone:763-286-5224
Practice Address - Fax:763-560-3137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN333391302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization